Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or North Carolina for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to North Carolina only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. North Carolina (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Sunshine Pediatrics, PA (NPI 1093096141)

Sunshine Pediatrics, PA is a pediatrics physician provider located in Smithfield, North Carolina. This profile covers 0 Medicare and 67 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Sunshine Pediatrics, PA
Address	1519 Booker Dairy Rd
City	Smithfield
State	NC
ZIP	27577
Taxonomy	Pediatrics Physician
NPI Enumerated	September 2, 2011

Payer Source	Total Paid
Medicaid	$11.5M
Medicare	$0

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

67 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	33,900	$110	$3.7M
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	15,390	$80	$1.2M
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	193,290	$10	$1.2M
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	18,650	$60	$1.2M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	6,810	$90	$598.9K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	5,420	$90	$487.5K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	2,920	$170	$482.1K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	5,830	$80	$466.3K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	5,670	$80	$436.8K
99205	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the provider…	1,450	$200	$282.4K

Showing 1–10 of 67

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other North Carolina providers billing the same CPT/HCPCS codes.

Claims Volume vs. North Carolina Distribution

Sunshine Pediatrics, PA — 7 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

67 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	180	2,850	10,910	$10	$330.3K
86769	The lab analyst performs a multiple–step immunoassay to evaluate the patient’s serum for antibodies to severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), which causes coronavirus disease…	9	30	530	$40	$316.7K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	79	4,400	960	$60	$271.3K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	87	520	1,080	$80	$262.1K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	92	550	970	$90	$258.9K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	216	4,130	670	$50	$219.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	49	590	490	$90	$179.8K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	30	380	460	$40	$173.1K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	23	530	270	$90	$112.8K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	238	630	840	$30	$101.2K

Showing 1–10 of 67

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Johnston Health Services Corporation	NC	General Acute Care Hospital	$0	$37.8M
Johnston County	NC	Land Ambulance	$2.4M	$7.9M
Johnston County Schools	NC	Local Education Agency (LEA)	$0	$8.5M
Carolina Outreach, LLC	NC	Mental Health Counselor	$0	$7.8M
Johnston County Public Health Department	NC	State or Local Public Health Clinic/Center	$0	$7.6M
Franklin Wefald	NC	Cardiovascular Disease Physician	$665.3K	$0
Mateen Akhtar	NC	Cardiovascular Disease Physician	$551.4K	$0
Bessaliea Griffin	NC	Foot & Ankle Surgery Podiatrist	$411.9K	$49.2K
Jason Moyer	NC	Optometrist	$169.7K	$259.3K
Octavio Cieza	NC	Infectious Disease Physician	$163.7K	$117.1K

Sunshine Pediatrics, PA — Billing Profile & Reimbursement Data

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Sunshine Pediatrics, PA — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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